Summary of Changes in the Ontario Physical Education Safety Guidelines Concussion Protocol (OPESGCP) & Implementation Tools

Transcription

1 Summary f Changes in the Ontari Physical Educatin Safety Guidelines Cncussin Prtcl (OPESGCP) & Implementatin Tls The fllwing dcument cntains a high-level summary* f the changes t the OPESGCP and Implementatin Tls (2018/2019 Ontari Physical Educatin Safety Guidelines). *Nte: This dcument is nt an exhaustive summary f all changes and is nt t replace reviewing the revised OPESGCP and Implementatin Tls (Appendix C1 C7). Appendix C-1 - Cncussin Prtcl: Preventin, Identificatin and Management Prcedures Appendix C-2 - Sample Tl t Identify a Suspected Cncussin Appendix C-3 - Sample Dcumentatin f Medical Assessment Appendix C-4 - Sample Dcumentatin fr Cncussin Management - Hme Preparatin fr Return t Schl (RTS) and Return t Physical Activity (RTPA) Plan Appendix C-5 - Sample Dcumentatin fr Schl Cncussin Management Return t Schl (RTS) and Return t Physical Activity (RTPA) Plan Appendix C-6 - Sample Dcumentatin fr Medical Clearance Appendix C-7 - Sample Cncussin Preventin Strategies Appendix C-1 - Cncussin Prtcl: Preventin, Identificatin and Management Prcedures This prtcl has been revised in partnership with Parachute In general much f the cntent in Appendix C-1 has been mdified t align with the Canadian Guideline n Cncussin in Sprt and the Berlin Cnsensus Statement n Cncussin in Sprt1 The rganizatin and frmat f Appendix C-1 has been mdified Cntext Added recent research that indicates prlnged rest until all symptms reslve is n lnger recmmended Infrmatin abut baseline testing has been added Cncussin Definitin This has been mdified and expanded includes a link t a visual illustratin f hw a cncussin ccurs 2 McCrry et al. (2017). Cnsensus statement n cncussin in sprt the 5 th internatinal cnference n cncussin in sprt held in Berlin, Octber British Jurnal f Sprts Medicine, 51 (11), * Minimum des nt refer t minimal safety standards but t the minimum requirements fr safety standards that must be fllwed in schl-based activities. The standards cntained in the Guidelines must nt be lwered. ***The Identificatin cmpnent is equivalent t the recgnitin cmpnent in the Canadian Guideline n Cncussin in Sprt. 1

2 Summary f Changes in the Ontari Physical Educatin Safety Guidelines Cncussin Prtcl (OPESGCP) & Implementatin Tls Medical Assessment Medical Assessment replaces the term Medical Examinatin As in previus prtcl, medical dctrs and nurse practitiners are the nly healthcare prfessinals in Canada qualified t prvide a cncussin diagnsis hwever a statement has been added fr rural r nrthern regins where the Medical Assessment may be cmpleted by a nurse with pre-arranged access t a medical dctr r nurse practitiner. Cmpnents f the Cncussin Prtcl Identificatin Cmpnent has been expanded and re-rganized includes fur "prcedures" (a - d) a) Initial Respnse - revised b) Initial Identificatin f a suspected cncussin - revised Red Flags signs, symptms and prcedure added Other Cncussin Signs and Symptms refrmatted t align with Cncussin Recgnitin Tl 5th Editin (CRT-5) frm Canadian Guideline n Cncussin in Sprt Quick Memry Functin Check included c) Steps required fllwing the initial identificatin f a suspected cncussin Teacher Respnse mdified slightly Infrmatin prvided t Parent/Guardian mdified Respnsibilities f Schl Principal/Designate mdified d) Steps required when sign(s) and r symptm(s) are nt identified but a pssible cncussin event is recgnized Student des nt return t physical activity that day and is mnitred fr 24 hurs fr emergence f sign(s) and r symptm(s) Teacher/Cach respnse expanded Infrmatin t be prvided t Parent/Guardian mdified and expanded Respnsibilities f Schl Principal/Designate mdified and expanded Management Cmpnent: Prcedures fr a Diagnsed Cncussin - Return t Schl (RTS) and Return t Physical Activity (RTPA) - new name General infrmatin mdified t include descriptin f the new RTS and mdified RTPA plan Includes tw parts, the first part ccurs at hme and prepares student fr the secnd part which ccurs at schl Includes ptential rle f ther licensed healthcare prfessinal in the management f a diagnsed cncussin Respnsibilities f the Schl Principal/Designate - includes new and mdified infrmatin Table3: Hme Preparatin fr Return t Schl (RTS) and Return t Physical Activity (RTPA) - new table and new infrmatin 2

3 Summary f Changes in the Ontari Physical Educatin Safety Guidelines Cncussin Prtcl (OPESGCP) & Implementatin Tls These stages ccur under the supervisin f the parent/guardian in cnsultatin with the medical dctr r nurse practitiner r ther licensed healthcare prfessinal Initial Rest perid mdified and expanded in bth RTS and RTPA RTS - Stages 1 and 2 are new RTPA - Stages 1 and 2a are new RTPA - Stage 2b is a mdificatin f "Step 2" - Return t Physical Activity in frmer OPESGCP Student is ready t return t schl - majrity f infrmatin is new Respnsibilities f Schl Principal/Designate Meeting with parents re: prcedures and dcumentatin f prcess - includes mainly new infrmatin Explanatin f Cllabrative team apprach - revised Table 4: Schl Cncussin Management Return t Schl (RTS) and Return t Physical Activity (RTPA) Stages - new table and infrmatin Intrductin t Table 4 - new infrmatin RTS - Stages 3a, 3b, 4a, 4b are new RTPA - Stages 3,4,5,6 - revised versin f "Steps 3-6" f Return t Physical Activity in frmer OPESGCP Cllabrative Team Apprach - revised and expanded infrmatin Table 5: Sample Return t Schl Strategies and/r Appraches2 - n changes Chart 1 - "Identifying a Suspected Cncussin - Steps and Respnsibilities", and Chart 2 - "Diagnsed Cncussin - Stages and Respnsibilities" - restructured with new infrmatin (as cmpared t "Chart 1: Steps and Respnsibilities in Suspected and Diagnsed Cncussins) in frmer versin f OPESGCP Appendix C-2 - Sample Tl t Identify a Suspected Cncussin Text Bx - The descriptive purpse f C-2 expanded smewhat Time f the Incident (a.m. r p.m.) has been added Identificatin f Suspected Cncussin mdified t align with "new" definitin f cncussin in C-1 The Identificatin prcess is rganized int tw steps and aligns with the cntent f CRT-5. Step A: Red Flag Sign(s) and r Symptm(s) and prcedure - call 911; Step B: Other Sign(s) and Symptm(s) Step B1: Other Sign(s) Step B2: Other Symptm(s) Step B3: Quick Memry Functin Check - ne questin was revised "What part f the day is it?" 2 Adapted frm Davis GA, Purcell LK. The evaluatin and management f acute cncussin differs in yung children. Br J Sprts Med. Published Online First 23 April 2013 di: /bjsprts

4 Summary f Changes in the Ontari Physical Educatin Safety Guidelines Cncussin Prtcl (OPESGCP) & Implementatin Tls The Actins Required: Step C: when sign(s) bserved and/r symptm(s) are reprted, and/r if the student fails t answer any f the Quick Memry Functin questins crrectly; Cntent is very similar but expanded t include infrmatin re: prvisin f Appendix C-3 - Sample Dcumentatin f Medical Assessment. Step D: when there are n signs bserved, nr symptms reprted, and the student answers crrectly all questins in the Quick Memry Functin Check but a pssible cncussin event was recgnized by teacher/cach Student des nt return t physical activity that day but is mnitred fr 24 hurs new frmat and cntent expanded, but similar t #4 n frmer C-2 Cmmunicatin t Parent/Guardian: Summary f Suspected Cncussin Check: A checklist t indicate results f C-2 appraisal/check The prvisin f Appendix C-3 - Dcumentatin f Medical Assessment t parent/guardian Appendix C-3 - Sample Dcumentatin f Medical Assessment Name f appendix revised - frmerly "Sample Dcumentatin f Medical Examinatin" Frmat f the dcument has been revised slightly, and cntent nw includes: Infrmatin in the shaded text bx mdified t align with revisins in C-1 and references Appendix C-2 fr mre infrmatin. Under "Results f Medical Assessment" a third ptin is listed in which the medical dctr/nurse practitiner can describe an alternate diagnsis and prvide recmmendatins The name and phne number f the medical dctr/nurse practitiner wh prvided the assessment are nw required. Secnd page has been added: A summarized chart f "Hme Preparatin fr Return t Schl (RTS) and Return t Physical Activity (RTPA) Plan" is included fr parent/guardian and medical dctr/nurse practitiner reference 4

5 Summary f Changes in the Ontari Physical Educatin Safety Guidelines Cncussin Prtcl (OPESGCP) & Implementatin Tls Appendix C-4 - Sample Dcumentatin fr Cncussin Management - Hme Preparatin fr Return t Schl (RTS) and Return t Physical Activity (RTPA) Plan* Frmerly "Appendix C-4 Sample Dcumentatin fr a Diagnsed Cncussin Return t Learn/Return t Physical Activity Plan" cntains all new cntent. It aligns with "Table3: Hme Preparatin fr Return t Schl (RTS) and Return t Physical Activity (RTPA) in Appendix C-1 and includes: Backgrund Infrmatin n the Cncussin Recvery Prcess General Prcedures fr Hme Preparatin fr RTS and RTPA Plan Instructins fr the parent/guardian n the use f the tl The chart f the hme preparatin f RTS and RTPA plan in which the: Initial Rest perid is mdified and expanded in bth RTS and RTPA RTS - Stages 1 and 2 are new RTPA - Stages 1 and 2a are new RTPA - Stage 2b is a mdificatin f "Step 2" - Return t Physical Activity in frmer OPESGCP Fllwing a brief descriptin f the stage, at each stage f the RTS and RTPA Plan, sample activities that are "permitted" and "nt permitted" are listed. At the end f each stage check bxes are prvided t indicate when the student may prgress t the next stage A student that has exhibited r reprted a return f symptms, r new symptms must return t the previus stage fr a minimum f 24 hurs A student that has exhibited r reprted a wrsening f symptms must return t medical dctr r nurse practitiner. Parent/guardian signature is required t indicate that student has cmpleted all stages prir t returning t schl t begin the schl part f the RTS and RTPA Plan (Appendix C-5) 5

6 Summary f Changes in the Ontari Physical Educatin Safety Guidelines Cncussin Prtcl (OPESGCP) & Implementatin Tls Appendix C-5 - Sample Dcumentatin fr Schl Cncussin Management Return t Schl (RTS) and Return t Physical Activity (RTPA) Plan Frmerly "Appendix C-5 Sample Cncussin Preventin Strategies" - cntains all new cntent. It aligns with " Table 4: Return t Schl (RTS) and Return t Physical Activity (RTPA) Stages in Appendix C-1 and includes: Backgrund infrmatin n the cncussin recvery prcess that ccurs at schl General Prcedures fr Schl Cncussin Management Return t Schl (RTS) and Return t Physical Activity Plan (RTPA) Instructins regarding the use f the tl fr bth the schl and the parent/guardian The chart f the schl cncussin management f RTS and RTPA plan in which the: RTS - Stages 3a, 3b, 4a, 4b are new RTPA - Stages 3,4,5,6 - revised versin f "Steps 3-6" f Return t Physical Activity in frmer OPESGCP Fllwing a brief descriptin f the stage, at each stage f the RTS and RTPA Plan, sample activities that are "permitted" and "nt permitted" are listed. At the end f each stage check bxes are t be cmpleted by bth the schl and hme t indicate when the student may prgress t the next stage During all stages f RTS and in Stages 1-4 f RTPA: If symptms return r new symptms appear, the student returns t previus stage fr a minimum f 24 hurs and nly participates in activities that can be tlerated If student exhibits r reprts a wrsening f symptms, must return t medical dctr r nurse practitiner During stages 5 and 6 f RTPA, if symptms return r new symptms appear the student must return t medical dctr r nurse practitiner t have the Medical Clearance re-assessed At the end f each stage: The schl (e.g., cllabrative team lead/designate) must cmplete the check bx, initial and date that the student has cmpleted the schl "activities" The parent/guardian must cmplete the check bx(es) regarding the student's symptms and sign, date and cmment if apprpriate Prir t prgressing t RTPA Stage 5, a signed Medical Clearance frm a medical dctr/nurse practitiner must be btained 6

7 Summary f Changes in the Ontari Physical Educatin Safety Guidelines Cncussin Prtcl (OPESGCP) & Implementatin Tls Appendix C-6 - Sample Dcumentatin fr Medical Clearance This is a new tl that must be btained prir t the student prgressing t RTPA stage 5 and must be returned t the schl Appendix C-7 - Sample Cncussin Preventin Strategies Frmerly Appendix C-5 - Sample Cncussin Preventin Strategies - n revisins 7